Polyethylene glycol based prodrug of adrenomedullin and use thereof

ABSTRACT

The invention relates to novel polyethylene glycol (PEG) based prodrug of Adrenomedullin, to processes for preparation thereof, to the use thereof for treatment and/or prevention of diseases, and to the use thereof for producing medicaments for treatment and/or prevention of diseases, especially of cardiovascular, edematous and/or inflammatory disorders.

The invention relates to novel polyethylene glycol (PEG) based prodrugof Adrenomedullin, to processes for preparation thereof, to the usethereof for treatment and/or prevention of diseases, and to the usethereof for producing medicaments for treatment and/or prevention ofdiseases, especially of cardiovascular, edematous and/or inflammatorydisorders.

The 52 amino acid peptide hormone adrenomedullin (ADM) is produced inadrenal gland, lung, kidney, heart muscle and other organs. The plasmalevels of ADM are in the lower picomolar range. ADM is a member of thecalcitonin gene-related peptide (CGRP) family of peptides and as suchbinds to a heterodimeric G-protein coupled receptor that consists ofCRLR and RAMP 2 or 3 (Calcitonin-receptor-like receptor and receptoractivity modifying protein 2 or 3). Activation of the ADM receptor leadsto intracellular elevation of adenosine 3′, 5′-cyclic monophosphate(cAMP) in the receptor-bearing cells. ADM receptors are present ondifferent cell types in almost all organs including endothelial cells.ADM is thought to be metabolized by neutral endopeptidase and ispredominantly cleared in the lung where ADM-receptors are highlyexpressed [for review see Gibbons C., Dackor R., Dunworth W., Fritz-SixK., Caron K. M., Mol Endocrinol 21(4),783-796 (2007)].

Experimental data from the literature suggest that ADM is involved in avariety of functional roles that include, among others, blood pressureregulation, bronchodilatation, renal function, hormone secretion, cellgrowth, differentiation, neurotransmission, and modulation of the immuneresponse. Moreover ADM plays a crucial role as autocrine factor duringproliferation and regeneration of endothelial cells [for review seeGarcia M. A., Martin-Santamaria S., de Pascual-Teresa B., Ramos A.,Julián M., Martinez A., Expert Opin Ther Targets, 10(2), 303-317 (2006)]

There is an extensive body of evidence from the literature which showsthat ADM is indispensable for an intact endothelial barrier function andthat administration of ADM to supra-physiological levels exerts stronganti-edematous and anti-inflammatory functions in a variety ofinflammatory conditions in animal experiments including sepsis, acutelung injury and inflammation of the intestine [for review seeTemmesfeld-Wollbrick B., Hocke A. C., Suttorp N., Hippenstiel S., ThrombHaemost; 98, 944-951 (2007)]

Clinical testing of ADM was so far conducted in cardiovascularindications with a measurable hemodynamic end point such as pulmonaryhypertension, hypertension, heart failure and acute myocardialinfarction. ADM showed hemodynamic effects in several studies inpatients suffering from the aforementioned conditions. However, effectswere only short lasting and immediately ceasing after the end ofadministration. This findings correlated well with the knownpharmacokinetic profile of ADM. Pharmacodynamic effects comprised amongothers lowering of systemic and pulmonary arterial blood pressure andincrease of cardiac output [Troughton R. W., Lewis L. K., Yandle T. G.,Richards A. M., Nicholls M. G., Hypertension, 36(4), 588-93 (2000);Nagaya N., Kangawa K., Peptides, 25(11), 2013-8 (2004); Kataoka Y.,Miyazaki S., Yasuda S., Nagaya N., Noguchi T., Yamada N., Morii I.,Kawamura A., Doi K., Miyatake K., Tomoike H., Kangawa K., J CardiovascPharmacol, 56(4), 413-9 (2010)]

In summary, based on evidence from a wealth of experimental data inanimals and first clinical trials in man elevation of ADM tosupraphysiological levels might be considered as a target mechanism forthe treatment of a variety of disease conditions in man and animals.However, the major limitations of the use of ADM as therapeutic agentare the inconvenient applicability of continuous infusion therapy whichprecludes its use for most of the potential indications and thepotentially limited safety margins with respect to hypotension which mayresult from bolus administrations of ADM.

The object of the present invention is to provide novel compounds whichcan be employed for the treatment of diseases, in particularcardiovascular, edematous and inflammatory disorders.

Many therapeutically active peptides or proteins suffer from highclearance in vivo. Several approaches to form an injectable depot ofsuch drugs exist that involve the use of macromolecules.

Polymer matrices that contain a drug molecule in a non covalently boundstate are well known. These can also be injectable as hydro gels, microparticles or micelles. The release kinetics of such drug products can bequite unreliable with high inter patient variability. Production of suchpolymers can harm the sensitive drug substance or it can undergo sidereactions with the polymer during its degradation (D. H. Lee et al., J.Contr. Rel., 2003, 92, 291-299).

Permanent PEGylation of peptides or proteins to enhance theirsolubility, reduce immunogenicity and increase half live by reducingrenal clearance is a well known concept since early 1980s (Caliceti P.,Veronese F. M., Adv. Drug Deliv. Rev.2003, 55, 1261-1277). For severaldrugs this has been used with success, but with many examples thePEGylation reduces efficacy of drug substance to an extent that thisconcept is not suitable any more (T. Peleg-Shulman et al., J. Med.Chem., 2004, 47, 4897-4904).

A suitable alternative are polymer based prodrugs. The currentdefinitions for prodrugs by the IUPAC state the following terms(International Union of Pure and Applied Chemistry and InternationalUnion of Biochemistry: GLOSSARY OF TERMS USED IN MEDICINAL CHEMISTRY(Recommendations 1998); in Pure & Appl. Chem. Vol 70, No. 5, 1998, p.1129-1143):

Prodrug: A prodrug is any compound that undergoes biotransformationbefore exhibiting its pharmacological effects. Prodrugs can thus beviewed as drugs containing specialized non-toxic protective groups usedin a transient manner to alter or to eliminate undesirable properties inthe parent molecule.

Carrier-linked prodrug (Carrier prodrug): A carrier-linked prodrug is aprodrug that contains a temporary linkage of a given active substancewith a transient carrier group that produces improved physicochemical orpharmacokinetic properties and that can be easily removed in vivo,usually by a hydrolytic cleavage.

Cascade prodrug: A cascade prodrug is a prodrug for which the cleavageof the carrier group becomes effective only after unmasking anactivating group.

Several examples of PEG-based carrier prodrugs exist, most of them withthe need for enzymatic activation of the linker between the active drugand the carrier, mostly initiated by enzymatic hydrolysis. Since estersare cleaved very readily and unpredictably in vivo, direct ester linkersfor carrier pro drug have limitations to their usability (J. Rautio etal., Nature Reviews Drug discovery, 2008, 7 255-270).

Commonly used alternative approaches are cascading linkers attached toan amine functionality in the peptide or protein. In cascading linkers amasking group has to be removed as the rate limiting step in thecascade. This activates the linker to decompose in a second position torelease the peptide or protein. Commonly the masking group can beremoved by an enzymatic mechanism (R. B. Greenwald et al. inWO2002/089789, Greenwald, et al., J. Med. Chem. 1999, 42, 3657-3667, F.M. H. DeGroot et al. in WO2002/083180 and WO02004/043493, and D. Shabatet al. in WO2004/019993).

An alternative not relying on enzymatic activation is the concept of U.Hersel et al. in WO2005/099768. In their approach the masking group on aphenol is removed in a purely pH dependent manner by the attack of aninternal nucleophile. This activates the linker for furtherdecomposition.

As mentioned by U. Hersel et al. in WO2005/099768, “The disadvantage inthe abovementioned prodrug systems described by Greenwald, DeGroot andShabat is the release of potentially toxic aromatic small molecule sideproducts like quinone methides after cleavage of the temporary linkage.The potentially toxic entities are released in a 1:1 stoichiometry withthe drug and can assume high in vivo concentrations.” The same problemholds true for the system by Hersel et al. as well.

For small organic molecules a plethora of different prodrug approachesexist (J. Rautio et al., Nature Reviews Drug discovery, 2008, 7255-270). The approach used by U. Hersel et al. as release mechanism fortheir masking group has been used as a prodrug approach for phenolicgroups of small molecules since the late 1980s. (W. S. Saari in EP 0296811 and W. S. Saari et al., J. Med. Chem. 1990, Vol 33, No 1, p 97-101).

Alternative amine based prodrug system are based on the slow hydrolysisof bis-hydroxyethyl glycine as a cascading prodrug. The hydroxy groupsof the bis-hydroxyethyl glycine are masked by esters that are prone tohydrolysis by esterases (R. Greenwald et al., J. Med. Chem. 2004, 47,726-734 and D. Vetter et al. in WO 2006/136586).

Labeled Adrenomedullin derivatives for use as imaging and alsotherapeutic agent are known (J. Depuis et al. in CA 2567478 and WO2008/138141). In these ADM derivatives a complexating cage likemolecular structure capable of binding radioactive isotopes was attachedto the N terminus of ADM in a direct manner or via a spacer unitpotentially also including short PEG spacers. The diagnostic ortherapeutic value of theses drugs arises from the targeted delivery ofthe radioactive molecule.

In contrast to the prodrug approaches listed above, which are all basedon masking amine functionalities, the current invention is based onmasking the phenolic group of a tyrosine in ADM. A carrier-linkedprodrug is used, based on the internal nucleophile assisted cleavage ofa carbamate on this phenolic group. The key advantage to other prodrugclasses mentioned above is the toxicological harmlessness of the linkerdecomposition product, a cyclic urea permanently attached to thecarrier. Furthermore, the decomposition of the prodrug is not dependenton enzymatic mechanisms that might cause a high inter patientvariability of cleavage kinetics. The cleavage mechanism is solely pHdependent as an internal amine that is protonated at acidic pH getsactivated at higher (neutral) pH to act as a nucleophile attacking thephenolic carbamate based on the tyrosine.

In the context of the present invention, compounds are now describedwhich act as slow release ADM-prodrugs with extended duration ofpharmacological action as compared to ADM and which on the basis of thisspecific action mechanism—after parenteral administration—exert in vivosustained anti-inflammatory and hemodynamic effects such asstabilization of endothelial barrier function, and reduction of bloodpressure, respectively.

The present invention provides compounds of the formula

in whichn represents the number 0, 1, 2 or 3,R¹ represents hydrogen, methyl, ethyl, n-propyl or isopropyl,R² represents linear or branched PEG 20 kDa to 80 kDa endcapped with amethoxy-group,and salts thereof, solvates thereof and the solvates of salts thereof.

Compounds according to the invention are the compounds of the formula(I) and the salts thereof, solvates thereof and solvates of the saltsthereof, the compounds which are embraced by formula (I) and are of theformulae specified below and the salts thereof, solvates thereof andsolvates of the salts thereof, and the compounds which are embraced byformula (I) and are specified below as working examples and saltsthereof, solvates thereof and solvates of the salts thereof, if thecompounds which are embraced by formula (I) and are specified below arenot already salts, solvates and solvates of the salts.

Depending on their structure, the compounds according to the inventionmay exist in stereoisomeric forms (enantiomers, diastereomers). Theinvention therefore embraces the enantiomers or diastereomers and theparticular mixtures thereof. The stereoisomerieally homogeneousconstituents can be isolated in a known manner from such mixtures ofenantiomers and/or diastereomers.

When the compounds according to the invention can occur in tautomericforms, the present invention embraces all tautomeric forms.

In the context of the present invention, preferred salts arephysiologically acceptable salts of the compounds according to theinvention. Also included are salts which are not suitable themselves forpharmaceutical applications, but, for example, can be used for theisolation or purification of the compounds according to the invention.

Physiologically acceptable salts of the compounds according to theinvention include acid addition salts of mineral acids, carboxylic acidsand sulfonic acids, for example salts of hydrochloric acid, hydrobromicacid, sulfuric acid, phosphoric acid, methanesulfonic acid,ethanesulfonic acid, toluenesulfonic acid, benzenesulfonic acid,naphthalenedisulfonic acid, acetic acid, trifluoroacetic acid, propionicacid, lactic acid, tartaric acid, maleic acid, citric acid, fumaricacid, maleic acid and benzoic acid.

Physiologically acceptable salts of the compounds according to theinvention also include salts of customary bases, for example and withpreference alkali metal salts (e.g. sodium and potassium salts),alkaline earth metal salts (e.g. calcium and magnesium salts) andammonium salts derived from ammonia or organic amines having 1 to 16carbon atoms, for example and with preference ethylamine, diethylamine,triethylamine, ethyldiisopropylamine, monoethanolamine, diethanolamine,triethanolamine, dicyclohexylamine, dimethylaminoethanol, procaine,dibenzylamine, N-methylmorpholine, arginine, lysine, ethylenediamine andN-methylpiperidine.

In the context of the invention, solvates refer to those forms of thecompounds according to the invention which, in the solid or liquidstate, form a complex by coordination with solvent molecules. Hydratesare a specific form of the solvates, in which the coordination is withwater. Preferred solvates in the context of the present invention arehydrates.

In the context of the invention endcapped with a methoxy-group mentionedin R² means that the polyethylene glycol (PEG) is substituted with amethoxy group at the end which is not bond to the oxygen, i.e.—PEG 40kDa-OMe.

Preference is given to compounds of the formula (I) in which

n represents the number 1 or 2,R¹ represents hydrogen or methyl,R² represents linear PEG 40 kDa endcapped with a methoxy-group.

Preference is also given to compounds of the formula (I) in which

n represents the number 1 or 2,R¹ represents hydrogen,R² represents linear PEG 40 kDa endcapped with a methoxy-group.

Preference is also given to compounds of the formula (I) in which nrepresents the number 1.

Preference is also given to compounds of the formula (I) in which R¹represents hydrogen.

Preference is also given to compounds of the formula (I) in which thecarbon atom to which the —NHR¹ substituent is bonded has Sconfiguration.

Preference is also given to compounds of the formula (I) in which R²represents linear PEG 40 kDa endcapped with a methoxy-group.

Preference is also given to compounds of the formula (I) which have thestructure of the formula (Ia)

in whichn, R¹ and R² are each as defined above,and salts thereof, solvates thereof and the solvates of salts thereof.

The specific radical definitions given in the particular combinations orpreferred combinations of radicals are, irrespective of the particularcombination of the radical specified, also replaced by any radicaldefinitions of other combinations.

Very particular preference is given to combinations of two or more ofthe abovementioned preferred ranges.

The invention further provides a process for preparing the compounds ofthe formula (I), or salts thereof, solvates thereof or the solvates ofsalts thereof, wherein the compounds of the formula (II)

in whichn and R¹ are each as defined above,are reacted with the compounds of the formula (III)

in whichR² is as defined above.

The reaction is generally effected in inert solvents, preferably in atemperature range of 0° C. to 50° C. at standard pressure.

Inert solvents are, for example, citrate buffers, glycine-hydrochloridebuffers, phthalate buffers or acetate buffers of pH 3 to 5, preferencebeing given to a citrate buffer of pH 4.

The compound of the formula (III) is known or can be synthesized byknown processes from the appropriate starting compounds.

The compounds of the formula (II) are known or can be prepared byreacting compounds of the formula (IV)

in whichn and R¹ are each as defined above,in the first stage with the compound of the formula (V)

and in the second stage with an acid.

The reaction in the first stage is generally effected in inert solvents,in the presence of a dehydrating reagent, optionally in the presence ofa base, preferably in a temperature range from room temperature to 70°C. at standard pressure.

Inert solvents are, for example, halohydrocarbons such asdichloromethane, trichloromethane or 1,2-dichloroethane, ethers such asdioxane, tetrahydrofuran or 1,2-dimethoxyethane, or other solvents suchas acetone, dimethylformamide, dimethylacetamide, 2-butanone oracetonitrile. It is equally possible to use mixtures of the solvents.Preference is given to dimethylformamide.

Suitable dehydrating reagents in this context are, for example,carbodiimides, for example N,N′-diethyl-, N,N′-dipropyl-,N,N′-diisopropyl-, N,N′-dicyclohexylcarbodiimide,N-(3-dimethylamino-isopropyl)-N′-ethylcarbodiimide hydrochloride (EDC),N-cyclohexylcarbodiimide-N′-propyloxymethylpolystyrene(PS-carbodiimide), or carbonyl compounds such as carbonyldiimidazole, or1,2-oxazolium compounds such as 2-ethyl-5-phenyl-1,2-oxazolium3-sulphate or 2-tert-butyl-5-methylisoxazolium perchlorate, or acylaminocompounds such as 2-ethoxy-1-ethoxy-carbonyl-1,2-dihydroquinoline, orpropanephosphonic anhydride, or isobutyl chloroformate, orbis-(2-oxo-3-oxazolidinyl)phosphoryl chloride orbcnzotriazolyloxytri(dimethylamino)phosphonium hexafluorophosphate, orO-(benzotriazol-1-yl)-N,N,N′,N′-tetramethyluronium hexafluorophosphate(HBTU), benzotriazol-1-yl-N-tetramethyl-uronium tetrafluoroborate(TBTU), 2-(2-oxo-1-(2H)-pyridyl)-1,1,3,3-tetramethyluroniumtetrafluoroborate (TPTU) orO-(7-azabenzotriazol-yl)-N,N,N′,N′-tetramethyluroniumhexafluorophosphate (HATU), or 1-hydroxybenzotriazole (HOBt), orbenzotriazol-1-yloxytris(dimethylamino)phosphonium hexafluorophosphate(BOP), or benzotriazol-1-yloxytris(pyrrolidino)phosphoniumhexafluorophosphate (PYBOP), or N-hydroxysuccinimide, or mixtures ofthese with bases.

Bases are, for example, alkali metal carbonates, for example sodiumcarbonate or potassium carbonate, or sodium hydrogencarbonate orpotassium hydrogencarbonate, or organic bases such as trialkylamines,for example triethylamine, N-methylmorpholine, N-methylpiperidine,4-dimethylaminopyridine or N,N-diisopropylethylamine, preference beinggiven to N,N-diisopropylethylamine.

Preferably, the condensation is carried out with TBTU in the presence ofN,N-diisopropylethylamine.

The second stage reaction is optionally effected in inert solvents,preferably in a temperature range from room temperature to 60° C. atstandard pressure.

Inert solvents are, for example, halohydrocarbons such asdichloromethane, trichloromethane, carbon tetrachloride or1,2-dichloroethane, or ethers such as tetrahydrofuran or dioxane,preference being given to dichloromethane.

Acids are, for example, trifluoroacetic acid or hydrogen chloride indioxane, preference being given to concentrated trifluoroacetic acid.Concentrated trifluoroacetic acid can be used with addition ofscavengers like water, phenol, thioanisole and 1,2-ethanediol.Preference is given to 1 to 5% of each of these scavengers.

The compound of the formula (V) is known or can be synthesized by knownprocesses from the appropriate starting compounds (example 14A).

The compounds of the formula (IV) are known or can be prepared byreacting compounds of the formula (VI)

in whichn and R¹ are each as defined above,with a Palladium(0) source and a reducing agent.

The reaction is generally effected in inert solvents, optionally in thepresents of a weak base, preferably in a temperature range of 0° C. to50° C. at standard pressure.

Inert solvents are, for example, halohydrocarbons such asdichloromethane, trichloromethane or 1,2-dichloroethane, ethers such asdioxane, tetrahydrofuran or 1,2-dimethoxyethane, or other solvents suchas acetone, dimethylformnamide, dimethylacetamide, 2-butanone oracetonitrile. It is equally possible to use mixtures of the solvents.Preference is given to tetrahydrofuran.

Palladium(0) sources are, for example,tetrakis(triphenylphosphin)palladium(0),tris(dibenzylideneacetone)dipalladium(0) or Palladium(II) sources thatare reduced in situ to Palladium(0) during the reaction, preferencebeing given to tetrakis(triphenylphosphin)-palladium(0).

Reducing agents are, for example, formic acid or triethyl silan,preference being given to formic acid.

Bases are, for example, triethylamine, N,N-diisopropylethylamine orpotassium phosphate solution, preference being given to triethylamine.

The compounds of the formula (VI) are known or can be prepared byreacting compounds of the formula (VII)

in whichn and R¹ are each as defined above,with the compound of the formula (VIII)

The reaction is generally effected in inert solvents, in the presence ofa dehydrating reagent, optionally in the presence of a base, preferablyin a temperature range from room temperature to 70° C. at standardpressure.

Inert solvents are, for example, halohydrocarbons such asdichloromethane, trichloromethane or 1,2-dichloroethane, ethers such asdioxane, tetrahydrofuran or 1,2-dimethoxyethane, or other solvents suchas acetone, dimethylformamide, dimethylacetamide, 2-butanone oracetonitrile. It is equally possible to use mixtures of the solvents.Preference is given to dichloromethane.

Suitable dehydrating reagents in this context are, for example,carbodiimides, for example N,N′-diethyl-, N,N′-dipropyl-,N,N′-diisopropyl-, N,N′-dicyclohexylcarbodiimide,N-(3-dimethylamino-isopropyl)-N′-ethylcarbodiimide hydrochloride (EDC),N-cyclohexylcarbodiimide-N′-propyloxymethylpolystyrene(PS-carbodiimide), or carbonyl compounds such as carbonyldiimidazole, or1,2-oxazolium compounds such as 2-ethyl-5-phenyl-1,2-oxazolium3-sulphate or 2-tert-butyl-5-methylisoxazolium perchlorate, or acylaminocompounds such as 2-ethoxy-1-ethoxy-carbonyl-1,2-dihydroquinoline, orpropanephosphonic anhydride, or isobutyl chloroformate, orbis-(2-oxo-3-oxazolidinyl)phosphoryl chloride orbenzotriazolyloxytri(dimethylamino)phosphonium hexafluorophosphate, orO-(benzotriazol-1-yl)-N,N,N,N′-tetramethyluronium hexafluorophosphate(HBTU), benzotriazol-1-yl-N-tetramethyl-uronium tetrafluoroborate(TBTU), 2-(2-oxo-1-(2H)-pyridyl)-1,1,3,3-tetramethyluroniumtetrafluoroborate (TPTU) orO-(7-azabenzotriazol-1-yl)-N,N,N′,N′-tetramethyluroniumhexafluorophosphate (HATU), or 1-hydroxybenzotriazole (HOBt), orbenzotriazol-1-yloxytris(dimethylamino)phosphonium hexafluorophosphate(BOP), or benzotriazol-1-yloxytris(pyrrolidino)phosphoniumhexafluorophosphate (PYBOP), or N-hydroxysuccinimide, or mixtures ofthese with bases.

Bases are, for example, alkali metal carbonates, for example sodiumcarbonate or potassium carbonate, or sodium hydrogencarbonate orpotassium hydrogencarbonate, or organic bases such as trialkylamines,for example triethylamine, N-methylmorpholine, N-methylpiperidine,4-dimethylaminopyridine or N,N-diisopropylethylamine, preference beinggiven to N,N-diisopropylethylamine.

Preferably, the condensation is carried out with HATU in the presence ofN,N-diisopropylethylamine.

The compounds of the formula (VII) and (VIII) are known or can besynthesized by known processes from the appropriate starting compounds.

The preparation of the compounds according to the invention can beillustrated by the following synthesis scheme:

The compounds according to the invention show an unforeseeable usefulspectrum of pharmacological activity.

Accordingly they are suitable for use as medicaments for treatmentand/or prevention of diseases in humans and animals.

The compounds according to the invention are distinguished as specificadrenomedullin (ADM) releasing prodrugs.

The present invention further provides for the use of the compoundsaccording to the invention for treatment and/or prevention of disorders,especially of cardiovascular, edematous and/or inflammatory disorders.

For the present invention, the term “treatment” or “treating” includesinhibiting, delaying, relie-ving, mitigating, arresting, reducing, orcausing the regression of a disease, disorder, condition, or state, thedevelopment and/or progression thereof, and/or the symptoms thereof. Theterm “prevention” or “preventing” includes reducing the risk of having,contracting, or experiencing, a disease, disorder, condition, or state,the development and/or progression thereof, and/or the symptoms thereof.The term prevention includes prophylaxis. Treatment or prevention of adisease, disorder, condition, or state may be partial or complete.

On the basis of their pharmacological properties, the compoundsaccording to the invention can be employed for treatment and/orprevention of cardiovascular diseases, in particular heart failure,especially chronic and acute heart failure, diastolic and systolic(congestive) heart failure, acute decompensated heart failure, cardiacinsufficiency, coronary heart disease, angina pectoris, myocardialinfarction, ischemia reperfusion injury, ischemic and hemorrhagicstroke, arteriosclerosis, atherosclcrosis, hypertension, especiallyessential hypertension, malignant essential hypertension, secondaryhypertension, renovascular hypertension and hypertension secondary torenal and endocrine disorders, hypertensive heart disease, hypertensiverenal disease, pulmonary hypertension, especially secondary pulmonaryhypertension, pulmonary hypertension following pulmonary embolism withand without acute cor pulmonale, primary pulmonary hypertension, andperipheral arterial occlusive disease.

The compounds according to the invention are furthermore suitable fortreatment and/or prevention of gestational [pregnancy-induced] edema andproteinuria with and without hypertension (pre-eclampsia).

The compounds according to the invention are furthermore suitable fortreatment and/or prevention of pulmonary disorders, such as chronicobstructive pulmonary disease, asthma, acute and chronic pulmonaryedema, allergic alveolitis and pneumonitis due to inhaled organic dustand particles of fungal, actinomycetic or other origin, acute chemicalbronchitis, acute and chronic chemical pulmonary edema (e.g. afterinhalation of phosgene, nitrogen oxide), neurogenic pulmonary edema,acute and chronic pulmonary manifestations due to radiation, acute andchronic interstitial lung disorders (such as but not restricted todrug-induced interstitial lung disorders, e.g. secondary to Bleomycintreatment), acute lung injury/acute respiratory distress syndrome(ALI/ARDS) in adult or child including newborn, ALI/ARDS secondary topneumonia and sepsis, aspiration pneumonia and ALI/ARDS secondary toaspiration (such as but not restricted to aspiration pneumonia due toregurgitated gastric content), ALI/ARDS secondary to smoke gasinhalation, transfusion-related acute lung injury (TRALI), ALI/ARDS oracute pulmonary insufficiency following surgery, trauma or burns,ventilator induced lung injury (VILI), lung injury following meconiumaspiration, pulmonary fibrosis, and mountain sickness.

The compounds according to the invention are furthermore suitable fortreatment and/or prevention of chronic kidney diseases (stages 1-5),renal insufficiency, diabetic nephropathy, hypertensive chronic kidneydisease, glomerulonephritis, rapidly progressive and chronic nephriticsyndrome, unspecific nephritic syndrome, nephrotic syndrome, hereditarynephropathies, acute and chronic tubulo-interstitial nephritis, acutekidney injury, acute kidney failure, posttraumatic kidney failure,traumatic and postprocedural kidney injury, cardiorenal syndrome, andprotection and functional improvement of kidney transplants.

The compounds are morcover suitable for treatment and/or prevention ofdiabetes mellitus and its consecutive symptoms, such as e.g. diabeticmacro- and microangiopathy, diabetic nephropathy and neuropathy.

The compounds according to the invention can moreover be used fortreatment and/or prevention of disorders of the central and peripheralnervous system such as viral and bacterial meningitis and encephalitis(e.g. Zoster encephalitis), brain injury, primary or secondary[metastasis] malignant neoplasm of the brain and spinal cord,radiculitis and polyradiculitis, Guillain-Barre syndrome [acute(post-)infective polyneuritis, Miller Fisher Syndrome], amyotrophiclateral sclerosis [progressive spinal muscle atrophy], Parkinson'sdisease, acute and chronic polyneuropathies, pain, cerebral edema,Alzheimer's disease, degenerative diseases of the nervous system anddemyelinating diseases of the central nervous system such as but notrestricted to multiple sclerosis.

The compounds according to the invention are furthermore suitable fortreatment and/or prevention of portal hypertension and liver fibrosis[cirrhosis] and its sequelae such as esophageal varices and ascites, forthe treatment and/or prevention of pleural effusions secondary tomalignancies or inflammations and for the treatment and/or prevention oflymphedema and of edema secondary to varices.

The compounds according to the invention are furthermore suitable fortreatment and/or prevention of inflammatory disorders of thegastrointestinal tract such as inflammatory bowel disease, Crohn'sdisease, ulcerative colitis, and toxic and vascular disorders of theintestine.

The compounds according to the invention are furthermore suitable fortreatment and/or prevention of sepsis, septic shock, systemicinflammatory response syndrome (SIRS) of non-infectious origin,hemorrhagic shock, sepsis or SIRS with organ dysfunction or multi organfailure (MOF), traumatic shock, toxic shock, anaphylactic shock,urticaria, insect sting and bite-related allergies, angioneurotic edema[Giant urticaria, Quincke's edema], acute laryngitis and tracheitis, andacute obstructive laryngitis [croup] and epiglottitis.

The compounds are furthermore suitable for treatment and/or preventionof diseases of the rheumatic type and other disease forms to be countedas autoimmune diseases such as but not restricted to polyarthritis,lupus erythematodes, scleroderma, purpura and vasculitis.

The compounds according to the invention are furthermore suitable fortreatment of ocular hypertension (glaucoma), diabetic retinopathy andmacular edema.

The compounds according to the invention can moreover be used fortreatment and/or prevention of operation-related states of ischemia andconsecutive symptoms thereof after surgical interventions, in particularinterventions on the heart using a heart-lung machine (e.g. bypassoperations, heart valve implants), interventions on the carotidarteries, interventions on the aorta and interventions with instrumentalopening or penetration of the skull cap.

The compounds are furthermore suitable for general treatment and/orprevention in the event of surgical interventions with the aim ofaccelerating wound healing and shortening the reconvalescence time. Theyare further suited for the promotion of wound healing.

The compounds are furthermore suitable for treatment and/or preventionof disorders of bone density and structure such as but not restricted toosteoporosis, osteomalacia and hyperparathyroidism-related bonedisorders.

The compounds are furthermore suitable for treatment and/or preventionof sexual dysfunctions, in particular male erectile dysfunction.

Preferable the compounds are suitable for treatment and/or prevention ofheart failure, coronary heart disease, ischemic and/or hemorrhagicstroke, hypertension, pulmonary hypertension, peripheral arterialocclusive disease, pre-eclampsia, chronic obstructive pulmonary disease,asthma, acute and/or chronic pulmonary edema, allergic alveolitis and/orpneumonitis due to inhaled organic dust and particles of fungal,actinomycetic or other origin, and/or acute chemical bronchitis, acuteand/or chronic chemical pulmonary edema, neurogenic pulmonary edema,acute and/or chronic pulmonary manifestations due to radiation, acuteand/or chronic interstitial lung disorders, acute lung injury/acuterespiratory distress syndrome (ALI/ARDS) in adult or child includingnewborn, ALI/ARDS secondary to pneumonia and sepsis, aspirationpneumonia and ALI/ARDS secondary to aspiration, ALI/ARDS secondary tosmoke gas inhalation, transfusion-related acute lung injury (TRALI),ALI/ARDS and/or acute pulmonary insufficiency following surgery, traumaand/or burns, and/or ventilator induced lung injury (VILI), lung injuryfollowing meconium aspiration, pulmonary fibrosis, mountain sickness,chronic kidney diseases, glomerulonephritis, acute kidney injury,cardiorenal syndrome, lymphedema, inflammatory bowel disease, sepsis,septic shock, systemic inflammatory response syndrome (SIRS) ofnon-infectious origin, anaphylactic shock, inflammatory bowel diseaseand/or urticaria.

More preferable the compounds are suitable for treatment and/orprevention of heart failure, hypertension, pulmonary hypertension,asthma, acute and/or chronic chemical pulmonary edema, acute lunginjury/acute respiratory distress syndrome (ALI/ARDS) in adult or childincluding newborn, ALI/ARDS secondary to pneumonia and sepsis,aspiration pneumonia and ALI/ARDS secondary to aspiration, ALI/ARDSsecondary to smoke gas inhalation, transfusion-related acute lung injury(TRALI), ALI/ARDS and/or acute pulmonary insufficiency followingsurgery, trauma and/or burns, and/or ventilator induced lung injury(VILI), lung injury following meconium aspiration, sepsis, septic shock,systemic inflammatory response syndrome (SIRS) of non-infectious origin,anaphylactic shock, inflammatory bowel disease and/or urticaria.

The present invention further provides for the use of the compoundsaccording to the invention for treatment and/or prevention of disorders,in particular the disorders mentioned above.

The present invention further provides for the use of the compoundsaccording to the invention for preparing a medicament for treatmentand/or prevention of disorders, in particular the disorders mentionedabove.

The present invention further provides a method for treatment and/orprevention of disorders, in particular the disorders mentioned above,using an active amount of the compounds according to the invention.

The invention further provides medicaments comprising a compoundaccording to the invention and one or more further active ingredients,in particular for treatment and/or prevention of the disorders mentionedabove. Exemplary and preferred active ingredient combinations are:

ACE inhibitors, angiotensin receptor antagonists, beta-2 receptoragonists, phosphodiesterase inhibitors, glucocorticoid receptoragonists, diuretics, or recombinant angiotensin converting enzyme-2 oracetylsalicylic acid (aspirin).

In a preferred embodiment of the invention, the compounds according tothe invention are administered in combination with an ACE inhibitor,such as, by way of example and preferably, enalapril, quinapril,captopril, lisinopril, ramipril, delapril, fosinopril, perindopril,cilazapril, imidapril, benazepril, moexipril, spirapril or trandopril.

In a preferred embodiment of the invention, the compounds according tothe invention are administered in combination with an angiotensinreceptor antagonist, such as, by way of example and preferably,losartan, candesartan, valsartan, telmisartan or embusartan.

In a preferred embodiment of the invention, the compounds according tothe invention are administered in combination with a beta-2 receptoragonist, such as, by way of example and preferably, salbutamol,pirbuterol, salmeterol, terbutalin, fenoterol, tulobuterol, clenbuterol,reproterol or formoterol.

In a preferred embodiment of the invention, the compounds according tothe invention are administered in combination with a phosphodiesterase(PDE) inhibitor, such as, by way of example and preferably, milrinone,amrinone, pimobendan, cilostazol, sildenafil, vardenafil or tadalafil.

In a preferred embodiment of the invention, the compounds according tothe invention are administered in combination with a glucocorticoidreceptor agonist, such as, by way of example and preferably, cortiosol,cortisone, hydrocortisone, prednisone, methyl-prednisolone,prednylidene, deflazacort, fluocortolone, triameinolone, dexamethasoneor betamethasone.

In a preferred embodiment of the invention, the compounds according tothe invention are administered in combination with diuretics, such as,by way of example and preferably, furosemide, torasemide andhydrochlorothiazide.

The present invention further relates to medicaments which comprise atleast one compound according to the invention, normally together withone or more inert, nontoxic, pharmaceutically suitable excipients, andto the use thereof for the aforementioned purposes.

The compounds according to the invention can act systemically and/orlocally. For this purpose, they can be administered in a suitable way,for example by the parenteral, pulmonary, nasal, sublingual, lingual,buccal, dermal, transdermal, conjunctival, optic route or as implant orstent.

The compounds according to the invention can be administered inadministration forms suitable for these administration routes.

Parenteral administration can take place with avoidance of an absorptionstep (e.g. intravenous, intraarterial, intracardiac, intraspinal orintralumbar) or with inclusion of an absorption (e.g. intramuscular,subcutaneous, intracutaneous, percutaneous or intraperitoneal).Administration forms suitable for parenteral administration includepreparations for injection and infusion in the form of solutions,suspensions, emulsions, lyophilizates or sterile powders.

Suitable for the other administration routes are, for example,pharmaceutical forms for inhalation (including powder inhalers,nebulizers), nasal drops, eye drops, solutions or sprays; films/wafersor aqueous suspensions (lotions, shaking mixtures), lipophilicsuspensions, ointments, creams, transdermal therapeutic systems (e.g.patches), milk, pastes, foams, dusting powders, implants or stents.

Parenteral administration is preferred, especially intravenousadministration.

The compounds according to the invention can be converted into thestated administration forms. This can take place in a manner known perse by mixing with inert, nontoxic, pharmaceutically suitable excipients.These excipients include carriers (for example microcrystallinecellulose, lactose, mannitol), solvents (e.g. liquid polyethyleneglycols), emulsifiers and dispersants or wetting agents (for examplesodium dodecylsulfate, polyoxysorbitan oleate), binders (for examplepolyvinylpyrrolidone), synthetic and natural polymers (for examplealbumin), stabilizers (e.g. antioxidants, for example ascorbic acid),colors (e.g. inorganic pigments, for example iron oxides) and maskingflavors and/or odors.

It has generally been found to be advantageous, in the case ofparenteral administration, to administer amounts of about 0.001 to 5mg/kg, preferably about 0.01 to 1 mg/kg, of body weight to achieveeffective results.

It may nevertheless be necessary in some cases to deviate from thestated amounts, in particular as a function of the body weight, route ofadministration, individual response to the active ingredient, nature ofthe preparation and time or interval over which administration takesplace. For instance, less than the aforementioned minimum amount may besufficient in some cases, whereas in other cases the stated upper limitmust be exceeded. In the case of administration of larger amounts, itmay be advisable to divide these into a plurality of individual dosesover the day.

The following working examples illustrate the invention. The inventionis not restricted to the examples.

The percentages in the following tests and examples are, unless statedotherwise, percentages by weight; parts are parts by weight. Solventratios, dilution ratios and concentration data for the liquid/liquidsolutions are each based on volume.

A. EXAMPLES Abbreviations

-   -   AA amino acid    -   Acm acetamidomethyl    -   ADM adrenomedullin (human)    -   ADM(2-52) Peptide sequence of ADM AA 2 to AA 52, including        disulfide bond and C-terminal amide    -   approx. approximately    -   Boc tert-butyloxycarbonyl    -   CDI carbonyldiimidazole    -   d day(s), doublet (in NMR)    -   TLC thin-layer chromatography    -   DCI direct chemical ionization (in MS)    -   dd doublet of doublets (in NMR)    -   DIEA N,N-diisopropylethylamine    -   DMAP 4-dimethylaminopyridine    -   DMF N,N-dimethylformamide    -   DMSO dimethyl sulfoxide    -   of theory of theory (in yield)    -   eq. equivalent(s)    -   ESI electrospray ionization (in MS)    -   Fmoc (9H-fluoren-9-ylmethoxy)carbonyl    -   h hour(s)    -   HATU O-(7-azabenzotriazol-1-yl)-N,N,N′,N′-tetramethyluronium        hexafluorophosphate    -   HPLC high pressure, high performance liquid chromatography    -   LC-MS liquid chromatography-coupled mass spectroscopy    -   m multiplet (in NMR)    -   min minute(s)    -   MS mass spectroscopy    -   NMR nuclear magnetic resonance spectroscopy    -   pbf 2,2,4,6,7-pentamethyldihydrobenzofuran-5-sulfonyl    -   PEG polyethylene glycol    -   RP reversed phase (in HPLC)    -   RT room temperature    -   R_(t) retention time (in HPLC)    -   s singulet (in NMR)    -   TBTU benzotriazol-1-yl-N-tetramethyl-uronium tetrafluoroborate    -   tBu tert-butyl    -   TFA trifluoroacetic acid    -   THF tetrahydrofuran    -   Trt trityl

Nomenclature of amino acids and peptide sequences is according to:

International Union of Pure and Applied Chemistry and InternationalUnion of Biochemistry: Nomenclature and Symbolism for Amino Acids andPeptides (Recommendations 1983). In: Pure & Appl. Chem. 56, Vol. 5,1984, p. 595-624

Trivial Name Symbol One-letter Symbol Alanine Ala A Arginine Arg RAsparagine Asn N Aspartic acid Asp D Cysteine Cys C Glutamic acid Glu EGlutamine Gln Q Glycine Gly G Histidine His H Isoleucine Ile I LeucineLeu L Lysine Lys K Methionine Met M Phenylalanine Phe F Proline Pro PSerine Ser S Threonine Thr T Tryptophan Trp W Tyrosine Tyr Y Valine ValV

LC-MS and MS Methods

Method 1 (LC-MS): Instrument type: Waters ACQUITY SQD UPLC System;column: Waters Acquity UPLC HSS T3 1.8μ 50 mm×1 mm; mobile phase A: 1 lwater+0.25 ml 99% strength formic acid, mobile phase B: 1 lacetonitrile+0.25 ml 99% strength formic acid; gradient: 0.0 min 90%A→1.2 min 5% A→2.0 min 5% A; oven: 50° C.; flow: 0.40 ml/min;UV-detection: 210-400 nm.

Method 2 (LC-MS): MS instrument: type: Waters (Micromass) Quattro Micro;HPLC instrument type: Agilent 1100 series; column: Thermo Hypersil GOLD3μ 20 mm×4 mm; mobile phase A: 1 l water+0.5 ml 50% strength formicacid, mobile phase B: 1 l acetonitrile+0.5 ml 50% strength formic acid;gradient: 0.0 min 100% A→3.0 min 10% A→4.0 min 10% A; oven: 50° C.;flow: 2.0 ml/min; UV-detection: 210 nm.

Method 3 (HPLC): Instrument type: HP 1200 Series; UV DAD; column:Phenomenex Luna 5 μm C5 100 Å, 150 mm×4.6 mm; mobile phase A: 1 lwater+0.5 ml 50% strength formic acid, mobile phase B: 1 lacetonitrile+0.5 ml 50% strength formic acid; gradient: 0.0 min 95% A→5min 5% A; →5.8 min 95% A→6.2 min 95% A; flow rate: 2.5 ml/min; oven: RT;UV detection: 210 nm.

Method 4 (HPLC): Instrument type: HP 1200 Series; UV DAD; column: MerckChromolith Fastgradient RP18 50 mm×2 mm; mobile phase A: 1 l water+0.5ml 50% strength formic acid, mobile phase B: 1 l acetonitrile+0.5 ml 50%strength formic acid; gradient: 0.0 min 95% A→2.9 min 5% A→3.2 min 5% A;flow rate: 3 ml/min; oven: RT; UV detection: 210 nm.

Method 5 (DCI MS): Instrument type: Thermo Fisher-Scientific DSQ;chemical ionization; reactant ammonia gas; source temperature: 200° C.;inonization energy 70 eV.

Method 6 (MALDI MS): Instrument type Kratos PC-Kompact SEQ V1.2.2 MALDITOF MS, positive ionization mode, Linear high, Power: 75.

Microwave synthesizer: Biotage Emrys Initiator II synthesizer, withvariable vial size up to 20 ml reaction volume and “Robot 60” sampleprocessor

pH 4 citrate buffer: Fluka No 82566; Citrate buffer pH 4, stabilizedwith sodium azide composition: citric acid, ˜0.056 M; sodium azide,˜0.05%; sodium chloride, ˜0.044 M; sodium hydroxide, ˜0.068 M.

40 kDa methoxy poly(ethylene glycol) maleimido propionamide (linear 40 kmPEG maleimide); CAS No 724722-89-8; From Dr. Reddys Inc., Lot No233101301; Weight average molecular weight, Mw (GPC) 40500 Da;Polydispersity (GPC) 1.08.

Starting Compounds Example 1AAllyl-N-(tert-butoxycarbonyl)-O-[(4-nitrophenoxy)carbonyl]-L-tyrosinate

36.7 g (114.3 mmol) N-Boc-L-tyrosine allyl ester, 23.0 g (114.3 mmol)4-nitrophenyl chloroformate, 17.5 ml (125.7 mmol) triethylamine and 1.40g (11.4 mmol) 4-dimethylamino pyridine were combined in 1000 mldichloromethane and stirred at room temperature for 2 h. The reationmixture was extracted with approx. 500 ml water and with approx. 250 mlbrine and dried over approx. 100 g sodium sulfate. The solvent wasremoved by rotary evaporation (approx. 40° C., approx. 200 mbar, approx.30 min.) and the product was dissolved in warm diethyl ether andcrystallized over night at 4° C. The crystals were filtered of, washedwith cold diethyl ether and dried in high vacuum (approx. 0.1 mbar, 18h). The yield was 29.86 g, (59.6 mmol, 52% of theory) of the desiredproduct.

LC-MS (method 1): R_(t)=1.23 min., m/z=487 (M+H)⁺

Example 2A(2S)-4-{[(4-{(2S)-3-(Allyloxy)-2-[(tert-butoxycarbonyl)amino]-3-oxopropyl}phenoxy)carbonyl]-amino}-2-[(tert-butoxycarbonyl)amino]butanoicacid

4.0 g (8.22 mmol) of the compound from example 1A was dissolved in 60 mldichloromethane. 1.795 (8.22 mmol)(2S)-4-Amino-2-[(tert-butoxycarbonyl)amino]butanoic acid and 1.43 ml(8.22 mmol) N,N-diisopropylethylamine were added. The reaction mixturewas split into 3 portions. The portions were heated for 30 min in asealed tube at 75° C. in a microwave synthesizer. From the combinedreaction mixture the solvent was removed by rotary evaporation (approx.40° C., approx. 200 mbar, approx. 30 min.). The raw product wasdissolved in dichloromethane and chromatographed over approx. 600 mlsilica gel. Solvents used were dichloromethane/ethyl acetate 4/1,dichloromethane/ethyl acetate 1/1, dichloromethane/methanol 4/1 anddichloromethane/methanol 1/1. The product-containing fractions werecombined and concentrated to dryness under reduced pressure. This gave4.02 g (6.54 mmol, 80% of theory) of the desired product.

LC-MS (method 1): R_(t)=1.07 min., m/z=564 (M−H)⁻

Example 3A Allyl O-({(3S)-4-{[(2R)-1-amino-1-oxo-3-(tritylsulfanyl)propan-2-yl]amino}-3-[(tert-butoxy-carbonyl)amino]-4-oxobutyl}carbamoyl)-N-(tert-butoxycarbonyl)-L-tyrosinate

2.50 g (4.42 mmol) of the compound from example 2A was dissolved in 100ml dichloromethane. 1.602 g (4.42 mmol) S-Trityl-L-cysteinamide, 0.77 ml(4.42 mmol) N,N-diisopropylethylamine and 1.68 g (4.42 mmol) HATU wereadded. The reaction mixture was split into 5 portions. The portions wereheated for 30 min in a sealed tube at 60° C. in a microwave synthesizer.From the combined reaction mixture the solvent was removed by rotaryevaporation (approx. 40° C., approx. 200 mbar, approx. 30 min.). The rawproduct was dissolved in dichloromethane and chromatographed overapprox. 600 ml silica gel. Solvents used were dichloromethane/ethylacetate 2/1, dichloromethane/ethyl acetate 1/1, dichloromethane/methanol20/1 and dichloromethane/methanol 10/1. The product-containing fractionswere combined and concentrated to dryness under reduced pressure. Thisgave 4.12 g (3.30 mmol, 75% of theory, 73% purity) of the desiredproduct.

LC-MS (method 1): R_(t)=1.36 min., m/z=911 (M+H)⁺

Example 4A O-({(3S)-4-{[(2R)-1-Amino-1-oxo-3-(tritylsulfanyl)propan-2-yl]amino}-3-[(tert-butoxycarbonyl)-amino]-4-oxobutyl}carbamoyl)-N-(tert-butoxycarbonyl)-L-tyrosine

4.14 g (4.55 mmol) of the compound from example 3A was dissolved in 90ml tetrahydrofuran. 3.17 ml (22.8 mmol) triethylamine, 0.86 ml (22.8mmol) formic acid and 0.526 g (0.455 mmol)tetrakis(triphenylphosphin)palladium(0) were added. The reaction mixturewas stirred over night at room temperature. The reaction was dilutedwith approx. 100 ml water, and twice extracted with approx. 100 mldichloromethane. The combined organic phases were extracted with brine,dried over sodium sulfate and concentrated to dryness under reducedpressure. The raw product was dissolved in dichloromethane andchromatographed over approx. 500 ml silica gel. Solvents used weredichloromethane, dichloromethane/methanol 20/1 anddichloromethane/methanol 1/1. The product-containing fractions werecombined and concentrated to dryness under reduced pressure. This gave2.62 g raw product of 94.5% purity. The product was further purified bypreparative RP-HPLC on a C18 with a water/methanol gradient to yield2.35 g (2.70 mmol, 59% of theory) pure product.

LC-MS (method 1): R_(t)=1.22 min., m/z=871 (M+H)⁺

¹H-NMR (400 MHz, DMSO-d₆, δ/ppm): δ=7.92 (d, 1H), 7.65 (t, 1H),7.28-7.35 (m, 12H), 7.25-7.28 (t, 3H), 7.15-7.20 (m, 4H), 6.95 (d, 2H),4.29 (q, 1H), 4.00 (nm, 1H), 3.92 (m, 1H), 3.11 (m, 3H), 2.90 (m, 1H),2.36 (m, 2H), 1.84 (m, 1H), 1.68 (m, 1H), 1.34 (d, 18H).

Example 5A tert-Butyl-methyl(2-oxotetrahydrofuran-3-yl)carbamate

The compound was synthesized according to Alberico, Dino; Paquin,Jean-Francois; Lautens, Mark; Tetrahedron, 2005, vol. 61, p. 6283-6297.

5.18 g (25.7 mmol) tert-Butyl(tetrahydro-2-oxo-3-furanyl)carbamate, 4.81ml (77.2 mmol) iodomethane were dissolved in 100 ml of dry dimethylfomamide. The solution was cooled to 0° C. and 1.34 g (60% in mineraloil, 33.5 mmol) sodium hydride was added. The reaction was warmed toroom temperature and stirred over night. The reaction mixture was addedto approx. 400 ml water and the mixture was extracted three times withapprox. 300 ml ethyl acetate. The combined organic phases were driedover sodium sulfate and concentrated to dryness under reduced pressure.This gave 8.70 g (25.7 mmol, 100% of theory, 63% purity) of the desiredproduct.

The analytic data was in accordance with the literature. The product wasused in the next synthetic step without further purification.

Example 6A2-[(tert-Butoxycarbonyl)(methyl)amino]-4-(1,3-dioxo-1,3-dihydro-2H-isoindol-2-yl)butanoicacid

8.70 g (approx. 25 mmol, approx. 63% purity) of the compound fromexample 5A was dissolved in 560 ml dimethyl formamide. 8.23 g (44.4mmol) potassium ophtalimide were added and the reaction mixture washeated to 150° C. for 7 h. Approx. 400 ml of be solvent was removed byrotary evaporation (approx. 60° C., approx. 10 mbar, approx. 30 min.).The reaction mixture was poured onto a mixture of approx. 100 ml water,200 g ice and 15 ml acetic acid. After melting of the remaining ice thereaction mixture was filtered and the filtrate was extracted 3 timeswith approx. 100 ml dichloromethane. The combined organic phases weredried over sodium sulfate and concentrated to dryness under reducedpressure. The raw product was dissolved in dichloromethane andchromatographed over approx. 70 ml silica gel. Solvents used weredichloromethane/ethyl acetate 9/1 to dichloromethane/ethyl acetate 6/4.The product-containing fractions were combined and concentrated todryness under reduced pressure. This gave 2.39 g (6.04 mmol, 24% oftheory) product.

LC-MS (method 1): R_(t)=0.92 min., m/z=363 (M+H)⁺

Example 7A 4-Amino-2-[(tert-butoxycarbonyl)(methyl)amino]butanoic acid

11.8 g (32.6 mmol) of the compound from example 6A was dissolved inapprox. 640 ml ethanol and 23.8 ml (488 mmol) hydrazine hydrate wasadded to the reaction mixture. After stirring over night, the reactionmixture was filtered and the filtrate was concentrated to dryness underreduced pressure. The raw product was dissolved in ethanol and approx.50 g silica gel was added, the solvent was removed under reducedpressure. The resulting solid was added onto a approx. 500 g silica gelcolumn and chromatographed. Solvents used were dichloromethane/methanol9/1 to dichloromethane/methanol 1/1. The product-containing fractionswere combined and concentrated to dryness under reduced pressure. Thisgave 2.98 g (12.8 mmol, 39% of theory) product.

LC-MS (method 2): R_(t)=0.21 min., m/z=233 (M+H)⁺

DCI MS (method 5): m/z=233 (M+H)⁺

Example 8A4-{[(4-{(2S)-3-(Allyloxy)-2-[(tert-butoxycarbonyl)amino]-3-oxopropyl}phenoxy)carbonyl]-amino}-2-[(tert-butoxycarbonyl)(methyl)amino]butanoicacid

0.931 g (1.92 mmol) of the compound from example 1A was dissolved in 30ml dichloromethane. 0.455 g (1.92 mmol) of the compound from example 7Awas added. The reaction mixture was split into 2 portions. The portionswere heated for 30 min in a sealed tube at 80° C. in a microwavesynthesizer. From the combined reaction mixture the solvent was removedunder reduced pressure. The raw product was purified by preparativeRP-HPLC on a C18 column with a water methanol gradient from 9/1 to 1/9.The product-containing fractions were combined and concentrated todryness under reduced pressure. This gave 0.523 g (0.85 mmol, 44% oftheory) of the desired product as a mixture of 2 diastereomers.

LC-MS (method 1): R_(t)=1.08 and 1.11 min., m/z=578 (M−H)⁻

Example 9A AllylO-[(4-{[(2R)-1-amino-1-oxo-3-(tritylsulfanyl)propan-2-yl]amino}-3-[(tert-butoxycarbonyl)-(methyl)amino]-4-oxobutyl)carbamoyl]-N-(tert-butoxycarbonyl)-L-tyrosinate

2.24 g (3.86 mmol) of the compound from example 8A was dissolved in 100ml dichloromethane. 1.401 g (3.86 mmol) S-Trityl-L-cysteinamide, 0.67mil (3.86 mmol) N,N-diisopropylethylamine and 1.47 g (3.86 mmol) HATUwere added. The reaction mixture was split into 5 portions. The portionswere heated for 30 min in a sealed tube at 60° C. in a microwavesynthesizer. From the combined reaction mixture the solvent was removedby rotary evaporation (approx. 40° C., approx. 200 mbar, approx. 30min.). The raw product was purified by preparative RP-HPLC on a C18column with a water methanol gradient from 9/1 to 1/9. Theproduct-containing fractions were combined and concentrated to drynessunder reduced pressure. This gave 3.26 g (2.75 mmol, 71% of theory, 78%purity) of the desired product as a mixture of diastereomers.

LC-MS (method 1): R_(t)=1.41 and 1.43 min., m/z=924 (M+H)⁺

Example 10AO-[(4-{[(2R)-1-Amino-1-oxo-3-(tritylsulfanyl)propan-2-yl]amino}-3-[(tert-butoxycarbonyl)-(methyl)amino]-4-oxobutyl)carbamoyl]-N-(tert-butoxycarbonyl)-L-tyrosine

2.2 g (2.38 mmol) of the compound from example 9A was dissolved in 48 mltetrahydrofuran. 1.66 ml (11.9 mmol) triethylamine, 0.45 ml (11.9 mmol)formic acid and 0.275 g (0.238 mmol)tetrakis(triphenylphosphin)palladium(0) were added. The reaction mixturewas stirred over night at room temperature. The reaction was dilutedwith approx. 50 ml water and twice extracted with approx. 50 mldichloromethane. The combined organic phases were extracted with brine,dried over sodium sulfate and concentrated to dryness under reducedpressure. The raw product was dissolved in dichloromethane andchromatographed over approx. 100 g silica gel. Solvents used weredichloromethane, dichloromethane/methanol 50/1 anddichloromethane/methanol 4/1. The product-containing fractions werecombined and concentrated to dryness under reduced pressure. This gave1.44 g (1.61 mmol, 68% of theory) product as a mixture of diastereomers.

LC-MS (method 1): R_(t)=1.20 and 1.24 min., m/z=884 (M+H)⁺

¹H-NMR (400 MHz, DMSO-d₆, δ/ppm): δ=8.00 (m, 1H), 7.65-7.90 (m, 4H),7.18-7.35 (m, 18H), 7.10 (m, 2H), 6.96 (m, 4H), 4.60 (m, 1H), 4.46 (m,1H), 4.30 (m, 2H), 4.05 (m, 2H), 3.00 (m, 4H), 2.75 (m, 6H), 2.36 (m,3H), 2.00 (m, 2H), 1.82 (m, 2H), 1.40 (m, 3H), 1.35 (s, 18H).

Example 11AN⁵-[(4-{(2S)-3-(Allyloxy)-2-[(tert-butoxycarbonyl)amino]-3-oxopropyl}phenoxy)carbonyl]-N²-(tert-butoxycarbonyl)-L-ornithine

6.00 g (12.33 mmol) of the compound from example 1A was dissolved in 120ml dichloromethane. 2.57 g (12.33 mmol)N²-(tert-Butoxycarbonyl)-L-omithine was added. The reaction mixture wassplit into 6 portions. The portions were heated for 90 min in a sealedtube at 75° C. in a microwave synthesizer. The combined reaction mixturewas extracted with approx. 100 ml saturated ammonium chloride solution.The aqueous phase was twice back extracted with approx. 30 mldichloromethane each. The combined organic phases were extracted withapprox. 50 ml brine and dried over sodium sulfate. The solvent wasremoved under reduced pressure. The raw product was dissolved indichloromethane and chromatographed over approx. 600 ml silica gel.Solvents used were dichloromethane, dichloromethane/methanol 40/1 todichloromethane/methanol 1/1. The product-containing fractions werecombined and concentrated to dryness under reduced pressure. This gave2.63 g (4.06 mmol, 33% of theory, 89% purity) of the desired product.

LC-MS (method 1): R_(t)=1.03 min., m/z=578 (M−H)⁻

Example 12AN⁵-[(4-{(2S)-3-(Allyloxy)-2-[(tert-butoxycarbonyl)amino]-3-oxopropyl}phenoxy)carbonyl]-N²-(tert-butoxycarbonyl)-L-ornithyl-S-trityl-L-cysteinamide

1.20 g (2.07 mmol) of the compound from example 11A was dissolved in 48ml dichloromethane. 0.750 g (2.07 mmol) S-Trityl-L-cysteinamide, 0.36 ml(2.07 mmol) N,N-diisopropylethylamine and 0.787 g (2.07 mmol) HATU wereadded. The reaction mixture was split into 3 portions. The portions wereheated for 30 min in a sealed tube at 60° C. in a microwave synthesizer.From the combined reaction mixture the solvent was removed by rotaryevaporation (approx. 40° C., approx. 200 mbar, approx. 30 min.). The rawproduct was dissolved in dichloromethane and chromatographed overapprox. 400 ml silica gel. Solvents used were dichloromethane/ethylacetate 2/1, dichloromethane/ethyl acetate 1/1. The product-containingfractions were combined and concentrated to dryness under reducedpressure. This gave 1.30 g (1.5 mmol, 56% of theory, 82% purity) of thedesired product.

LC-MS (method 1): R_(t)=1.35 min., m/z=924 (M+H)⁺

Example 13AN²-(tert-Butoxycarbonyl)-N⁵-[(4-{(2S)-2-[(tert-butoxycarbonyl)amino]-2-carboxyethyl}phenoxy)-carbonyl]-L-ornithyl-S-trityl-L-cysteinamide

3.06 g (2.33 mmol) of the compound from example 12A was dissolved in 46ml tetrahydrofuran. 1.63 ml (11.6 mmol) triethylamine, 0.44 ml (11.6mmol) formic acid and 0.265 g (0.233 mmol)tetrakis(triphenylphosphin)palladium(0) were added. The reaction mixturewas stirred over night at room temperature. The reaction was dilutedwith approx. 50 ml water and twice extracted with approx. 50 mldichloromethane. The combined organic phases were extracted with brine,dried over sodium sulfate and concentrated to dryness under reducedpressure. The raw product was dissolved in dichloromethane andchromatographed over approx. 500 ml silica gel. Solvents used weredichloromethane, dichloromethane/methanol 40/1 anddichloromethane/methanol 1/1. The product-containing fractions werecombined and concentrated to dryness under reduced pressure. This gave1.40 g raw product of 86% purity. The product was further purified bypreparative RP-HPLC on a C18 column with a water/methanol gradient toyield 2 fractions: 0.93 g product (45% of theory).

LC-MS (method 1): R_(t)=1.18 min., m/z=885 (M+H)⁺

¹H-NMR (400 MHz, DMSO-d₆, δ/ppm): δ=7.89 (d, 1H), 7.65 (t, 1H),7.25-7.35 (m, 12H), 7.20-7.25 (m, 6H), 7.10-7.20 (m, 3H), 6.95 (d, 2H),4.29 (m, 1H), 4.05 (m, 1H), 3.88 (m, 1H), 3.11 (d, 1H), 3.00 (m, 4H),2.75 (m, 2H), 2.36 (m, 3H), 1.64 (m, 1H), 1.51 (m, 3H), 1.36 (s, 9H),1.32 (s, 9H).

Example 14A Tentagel Based Amide Resin Bound ADM (2-52)

The peptide was assembled stepwise on a Tentagel based amide resin on anautomated peptide synthesizer (Protein Technologies Inc. Symphony). 8poly-propylene reaction vessels were used in parallel perfoming theidentical chemistry. Each vessel was loaded with 0.05 mmol Tentagelbased Rink resin for a total batch size of 0.4 mmol.

Each amino acid is added in 8 fold molar access with regard to theloading of the resin. The amino acids were Fmoc protected as theN-terminal protecting group and the protecting groups indicated belowwere used for side chain functionalities. Also 188 mg (0.59 mmol, 7.8eq.) TBTU and 0.21 ml (1.2 mmol, 16 eq.) DIEA were added. Reactions wereperformed in DMF as solvent, whereas DMF was used in an amountsufficient to swell the resin and agitate it freely. Reaction time peramino acid was approx. 1 hour. Cleavage of the Fmoc protecting groupswas achieved using 20% piperidine/DMF, whereas 20% piperidine/DMF wasused in an amount sufficient to swell the resin and agitate it freely.

The coupling sequence was as follows:

-   -   1. Tyr(tBu) (Tyr=Y=AA 52 of human ADM)    -   2. Gly (Gly=G=AA 51 of human ADM)    -   3. Gln(Trt) (Gln=Q=AA 50 of human ADM)    -   4. Pro (Pro=P=AA 49 of human ADM)    -   5. Ser(tBu) (Ser=S=AA 48 of human ADM)    -   6. Ile (Ile=I=AA 47 of human ADM)    -   7. Lys(Boc) (Lys=K=AA 46 of human ADM)    -   8. Ser(tBu) (Ser=S=AA 45 of human ADM)    -   9. Arg(pbf) (Arg=R=AA 44 of human ADM)    -   10. Pro (Pro=P=AA 43 of human ADM)    -   11. Ala (Ala=A=AA 42 of human ADM)    -   12. Val (Val=V=AA 41 of human ADM)    -   13. Asn(Trt) (Asn=N=AA 40 of human ADM)    -   14. Asp(OtBu) (Asp=D=AA 39 of human ADM)    -   15. Lys(Boc) (Lys=K=AA 38 of human ADM)    -   16. Asp(OtBu) (Asp=D=AA 37 of human ADM)    -   17. Lys(Boc) (Lys=K=AA 36 of human ADM)    -   18. Asp(OtBu) (Asp=D=AA 35 of human ADM)    -   19. Thr(tBu) (Thr=T=AA 34 of human ADM)    -   20. Phe (Phe=F=AA 33 of human ADM)    -   21. Gln(Trt) (Gn=Q=AA 32 of human ADM)    -   22. Tyr(tBu) (Tyr=Y=AA 31 of human ADM)    -   23. Ile (Ile=I=AA 30 of human ADM)    -   24. Gln(Trt) (Gn=Q=AA 29 of human ADM)    -   25. His(Trt) (His=H=AA 28 of human ADM)    -   26. Ala (Ala=A=AA 27 of human ADM)    -   27. Leu (Leu=L=AA 26 of human ADM)    -   28. Lys(Boc) (Lys=K=AA 25 of human ADM)    -   29. Gln(Trt) (Gin=Q=AA 24 of human ADM)    -   30. Val (Val=V=AA 23 of human ADM)    -   31. Thr(tBu) (Thr=T=AA 22 of human ADM)    -   32. Cys(Trt) (Cys=C=AA 21 of human ADM)    -   33. Thr(tBu) (Thr=T=AA 20 of human ADM)    -   34. Gly (Gly=G=AA 19 of human ADM)    -   35. Phe (Phe=F=AA 18 of human ADM)    -   36. Arg(pbf) (Arg=R=AA 17 of human ADM)    -   37. Cys(Aem) (Cys=C=AA 16 of human ADM)    -   38. Gly (Gly=G=AA 15 of human ADM)    -   39. Phe (Phe=F=AA 14 of human ADM)    -   40. Ser(tBu) (Ser=S=AA 13 of human ADM)    -   41. Arg(pbf) (Arg=R=AA 12 of human ADM)    -   42. Leu (Leu=L=AA 11 of human ADM)    -   43. Gly (Gly=G=AA 10 of human ADM)    -   44. Gln(Trt) (Gln=Q=AA 9 of human ADM)    -   45. Phe (Phe=F=AA 8 of human ADM)    -   46. Asn(Trt) (Asn=N=AA 7 of human ADM)    -   47. Asn(Trt) (Asn=N=AA 6 of human ADM)    -   48. Met (Met=M=AA 5 of human ADM)    -   49. Ser(tBu) (Ser=S=AA 4 of human ADM)    -   50. Gln(Trt) (Gln=Q=AA 3 of human ADM)    -   51. Arg(pbf) (Arg=R=AA 2 of human ADM)

On-resin oxidation was achieved using Cys(Trt) and Cys(Acm) protectionwith concomitant cleavage of protecting groups and oxidation to adisulfide bond using Iodine (8 equivalents of Iodine plus 8 equivalentsof DIEA with a reaction time of 30 minutes). Oxidation was confirmed bysample cleavage and analysis using HPLC and MALDI-MS.

The 8 batches were pooled for further use.

Example 15AO-{[(3S)-3-Amino-4-{[(2R)-1-amino-1-oxo-3-sulfanylpropan-2-yl]amino}-4-oxobutyl]-carbamoyl}-L-tyrosyl-adrenomedullin(2-52)

To 0.075 mmol of the compound of example 14A 520 mg (0.6 mmol, 8 eq.) ofthe compound of example 4A were added. Also 188 mg (0.59 mmol, 7.8 eq.)TBTU and 0.21 ml (1.2 mmol, 16 eq.) DIEA were added. The reaction wasperformed with DMF as solvent, whereas DMF was used in an amountsufficient to swell the resin and agitate it freely. Reaction time wasapprox. 1 hour at room temperature. The peptide was cleaved from theresin with concomitant global deprotection using concentrated TFA in anamount sufficient to swell the resin and agitate it freely, whereas TFAcontains scavengers (1-5% each of water, phenol, thioanisole and1,2-ethanediol), with a reaction time of 2½ hrs. The crude product waslyophilised and purified by RP-chromatography using 0.1% TFA in waterand 0.1% TFA in acetonitrile as mobile phases to ensure that the pHremains below 4 at all times during the purification and lyophilisationprocess. All fractions containing the correct ion by MALDI-MS analysiswere pooled. The yield was 44.0 mg of partially purified peptide(approx. 0.0035 mmol, approx. 4.7% of theory; estimated purity: approx.50%, main impurity: ADM (2-52)).

MALDI MS (method 6): m/z=6275(M+H)⁺ and 5866 (impurity: (ADM(2-52)+H)⁺)

Example 16AO-{[4-{[(2R)-1-Amino-1-oxo-3-sulfanylpropan-2-yl]amino}-3-(methylamino)-4-oxobutyl]-carbamoyl}-L-tyrosyl-adrenomedullin(2-52)

To 0.075 mmol of the compound of example 14A 530 mg (0.6 mmol, 8 eq.) ofthe compound of example 10A were added. Also 188 mg (0.59 mmol, 7.8 eq.)TBTU and 0.21 ml (1.2 mmol, 16 eq.) DIEA were added. The reaction wasperformed with DMF as solvent, whereas DMF was used in an amountsufficient to swell the resin and agitate it freely. Reaction time wasapprox. 1 hour at room temperature. The peptide was cleaved from theresin with concomitant global deprotection using concentrated TFA in anamount sufficient to swell the resin and agitate it freely, whereas TFAcontains scavengers (1-5% each of water, phenol, thioanisole and1,2-ethanediol), with a reaction time of 2½ hrs. The crude product waslyophilised and purified by RP-chromatography using 0.1% TFA in waterand 0.1% TFA in acetonitrile as mobile phases to ensure that the pHremains below 4 at all times during the purification and lyophilisationprocess. All fractions containing the correct ion by MALDI-MS analysiswere pooled. The yield was 34.0 mg of partially purified peptide(approx. 0.0026 mmol, approx. 3.5% of theory; estimated purity: approx.50%, main impurity: ADM (2-52)).

MALDI MS (method 6): m/z=6289(M+H)⁺ and 5866 (impurity: (ADM(2-52)+H)⁺)

Example 17AO-{[(4R)-4-Amino-5-{[(2R)-1-amino-1-oxo-3-sulfanylpropan-2-yl]amino}-5-oxopentyl]-carbamoyl}-L-tyrosyl-adrenomedullin(2-52)

To 0.075 mmol of the compound of example 14A 530 mg (0.6 mmol, 8 eq.) ofthe compound of example 13A were added. Also 188 mg (0.59 mmol, 7.8 eq.)TBTU and 0.21 ml (1.2 mmol, 16 eq.) DIEA were added. The reaction wasperformed with DMF as solvent, whereas DMF was used in an amountsufficient to swell the resin and agitate it freely. Reaction time wasapprox. 1 hour at room temperature. The peptide was cleaved from theresin with concomitant global deprotection using concentrated TFA in anamount sufficient to swell the resin and agitate it freely, whereas TFAcontains scavengers (1-5% each of water, phenol, thioanisole and1,2-ethanediol), with a reaction time of 2½ hrs. The crude product waslyophilised and purified by RP-chromatography using 0.1% TFA in waterand 0.1% TFA in acetonitrile as mobile phases to ensure that the pHremains below 4 at all times during the purification and lyophilisationprocess. All fractions containing the correct ion by MALDI-MS analysiswere pooled. The yield was 47 mg of partially purified peptide (approx.0.0037 mmol, approx. 5.0% of theory; estimated purity: approx. 50%, mainimpurity: ADM (2-52)).

MALDI MS (method 6): m/z=6289(M+H)⁺ and 5866 (impurity: (ADM(2-52)+H)⁺)

WORKING EXAMPLES Example 1O-{[(3S)-3-Amino-4-({(2R)-1-amino-3-[(2,5-dioxo-1-{3-oxo-3-[(2-{ω-methoxy-poly-oxyethylen[40kDa]}ethyl)amino]propyl}pyrrolidin-3-yl)sulfanyl]-1-oxopropan-2-yl}amino)-4-oxobutyl]carbamoyl}-L-tyrosyl-adrenomedullin(2-52)

44 mg of the crude peptide of example 15A were stirred with 426 mg (10.5μmol, 1.5 eq, sourced from Dr. Reddys) 40 kDa methoxy poly(ethyleneglycol) maleimido propionamide in 9 ml citrate buffer of pH 4 over nightat room temperature. The crude reaction mixture was injected in twoportions onto a preparative HPLC system with a Phenomenex Luna 10μProteo C5 100A AXIA 250 mm×21.2 mm column and chromatographed with awater/acetonitrile (both with 0.1% TFA) gradient. The fractions werecollected in test tubes of 20 ml on an automated fraction collector. Toensure sufficient acidity each vial was filled with 0.5 ml acetic acidprior to collection.

ADM(2-52), which is the side product of example 15A and which did notundergo PEGylation in this reaction, as well as unreacted PEG wereremoved completely.

All fractions containing example 1 were combined. Acetonitrile waspartially removed on a rotary evaporator at 30° C. water bathtemperature and approx. 50 mbar for approx. 30 min.

After addition of 0.5 ml acetic acid, the remaining solution waslyophilized. The total yield of example 1 was 109 mg (2.35 μmol, 33% oftheory).

HPLC (method 3): R_(t)=4.23-4.30 min

Example 2O-{[(3-N-Methyl-amino-4-({(2R)-1-amino-3-[(2,5-dioxo-1-{3-oxo-3-[(2-{ω-methoxy-poly-oxyethylen[40kDa]}ethyl)amino]propyl}pyrrolidin-3-yl)sulfanyl]-1-oxopropan-2-yl}amino)-4-oxobutyl]carbamoyl}-L-tyrosyl-adrenomedullin(2-52)

15 mg of the crude peptide of example 16A were stirred with 145 mg (3.58μmol, 1.5 eq, sourced from Dr. Reddys) 40 kDa methoxy poly(ethyleneglycol) maleimido propionamide in 5 ml citrate buffer of pH 4 over nightat room temperature. The crude reaction mixture was injected onto apreparative HPLC system with a Phenomenex Jupiter 10μ C18 300A 250mm×21.2 mm column and chromatographed with a water/acetonitrile (bothwith 0.1% TFA) gradient. The fractions were collected in test tubes of20 ml on an automated fraction collector. To ensure sufficient acidityeach vial was filled with 0.5 ml acetic acid prior to collection.

ADM(2-52), which is the side product of example 16A and which did notundergo PEGylation in this reaction, as well as unreacted PEG wereremoved completely.

All fractions containing example 2 were combined. Acetonitrile waspartially removed on a rotary evaporator at 30° C. water bathtemperature and approx. 50 mbar for approx. 30 min.

After addition of 0.5 ml acetic acid, the remaining solution waslyophilized. The total yield of example 2 was 50 mg (1.08 μmol, 43% oftheory).

HPLC (method 4): R_(t)=2.02-2.08 min

Example 3O-{[(4S)-4-Amino-5-({(2R)-1-amino-3-[(2,5-dioxo-1-{3-oxo-3-[(2-{ω-methoxy-poly-oxyethylen[40kDa]}ethyl)amino]propyl}pyrrolidin-3-yl)sulfanyl]-1-oxopropan-2-yl}amino)-5-oxopentyl]carbamoyl}-L-tyrosyl-adrenomedullin(2-52)

15 mg of the crude peptide of example 17A were stirred with 145 mg (3.58μmol, 1.5 eq, sourced from Dr. Reddys) 40 kDa methoxy poly(ethyleneglycol) maleimido propionamide in 5 ml citrate buffer of pH 4 over nightat room temperature. The crude reaction mixture was injected onto apreparative HPLC system with a Phenomenex Jupiter 10μ Proteo 90A AXIA250 mm×21.2 mm column and chromatographed with a water/acetonitrile(both with 0.1% TFA) gradient. The fractions were collected in testtubes of 20 ml on an automated fraction collector. To ensure sufficientacidity each vial was filled with 0.5 ml acetic acid prior tocollection.

ADM(2-52), which is the side product of example 17A and which did notundergo PEGylation in this reaction, as well as unreacted PEG wereremoved completely.

All fractions containing example 3 were combined. Acetonitrile waspartially removed on a rotary evaporator at 30° C. water bathtemperature and approx. 50 mbar for approx. 30 min.

After addition of 0.5 ml acetic acid, the remaining solution waslyophilized. The total yield of example 3 was 19.5 mg (0.42 μmol, 17% oftheory).

HPLC (method 4): R_(t)=2.02-2.08 min

B. ASSESSMENT OF PHARMACOLOGICAL ACTIVITY

The suitability of the compounds according to the invention fortreatment of diseases can be demonstrated using the following assaysystems:

1) Test Descriptions (In Vitro) 1a) Tests on a RecombinantAdrenomedullin-Receptor Reporter Cell

The activity of the compounds according to the invention is quantifiedwith the aid of a recombinant Chinese hamster ovary (CHO) cell line thatcarries the human adrenomedullin-receptor. Activation of the receptor byligands can be measured by aequorin luminescence. Construction of thecell line and measurement procedure has been described in detail [WunderF., Rebmann A., Geerts A, and Kalthof B., Mol Pharmacol, 73, 1235-1243(2008)]. In brief: Cells are seeded on opaque 384-well nicrotiter platesat a density of 4000 cells/well and are grown for 24 b. After removal ofculture medium, cells are loaded for 3 h with 0.6 μg/ml coelenterazinein Ca²⁺-free Tyrode solution (130 mM sodium chloride, 5 mM potassiumchloride, 20 mM HIEPES (4-(2-hydroxyethyl)-1-piperazineethanesulfonicacid), 1 mM magnesium chloride, and 4.8 mM sodium hydrogen carbonate, pH7.4) supplemented with 0.2 mM 3-Isobutyl-1-methylxanthine (IBMX) in acell culture incubator. Compounds are added for 6 min in calcium²⁺-freeTyrode solution containing 0.1% bovine serum albumin. Immediately beforeadding calcium²⁺ to a final concentration of 3 mM measurement of theaequorin luminescence is started by use of a suitable luminometer.Luminescence is measured for 60 s. In a typical experiment compounds aretested in a concentration range of 1×10⁻¹³ to 3×10⁻⁶ M.

In order to determine the release of active adrenomedullin fromcompounds according to the invention, compounds are incubated atdifferent concentrations for different time spans up to 24 h in Tyrodesolution supplemented with fetal calf serum, cell culture medium orplasma from different species at pH 7.4. Calcium²⁺ content of therespective incubation media is buffered by addition of 4 mM EDTA(ethylene diamine tetraacetic acid) before adding samples to theadrenomedullin-receptor reporter cell.

After appropriate preincubation, the embodiment examples activate theadrenomedullin-receptor reporter cell more potently than beforepreincubation. This is indicated by the fact that EC₅₀ values aredetermined by a factor of up to 10 smaller after preincubation thanbefore and is explainable by the relase of active adrenomedullin fromthe compounds.

Representative EC₅₀ values for the embodiment examples before and afterincubation for 24 h in buffer supplemented with 2.5% fetal calf serumare given in the following Table 1:

TABLE 1 Example no. EC₅₀ T = 0 h [nM] EC₅₀ T = 24 h [nM] ADM 0.5 2.5 1110 8.4 2 >1000 161 3 124 12.3

1b) Transcellular Electrical Resistance Assays in Endothelial Cells

The activity of the compounds according to the invention ischaracterized in in vitro-permeability assays in human umbilical venouscells (HUVEC, Lonza). By use of the ECIS apparatus (ECIS: ElectricCell-substrate Impedance Sensing; Applied Biophysics Inc; Troy, N.Y.)changes of transendothelial electrical resistance (TEER) over anendothelial monolayer are continuously measured by use of a small goldelectrode on which the cells have been seeded. HUVEC are grown on the96-well sensor electrode plates (96W1E, Ibidi GmbH, Martinsried) toconfluent monolayers and hyperpermeability can be induced byinflammatory stimuli such as Thrombin, TNF-α, IL-1β, VEGF, Histamine andhydrogen peroxide which all have been demonstrated to cause break downof endothelial cell contacts and reduction of TEER. Thrombin is used ata final concentration of 0.5 U/ml. Test compounds are added before orafter addition of thrombin. In a typical experiment compounds are testedin a concentration range of 1×10⁻¹⁰ to 1×10⁻⁶ M.

The embodiment examples inhibit the thrombin induced hyperpermeabilityin this test at concentrations of ≦10⁻⁶ M.

1c) In Vitro-Permeability Assays in Endothelial Cells

In another in vitro model of endothelial hyperpermeability the activityof compounds according to the invention is examined with respect tomodulation of macromolecular permeability. Human umbilical veinendothelial cells (HUVECS) are grown to confluency on fibronectin-coatedTranswell® filter membranes (24-well plates, 6.5 mm-inserts with 0.4 Mpolycarbonate membrane; Costar #3413) which separate an upper from alower tissue culture chamber with endothelial cells growing on thebottom of the upper chamber. The medium of the upper chamber issupplemented with 250 μg/ml of 40 kDa FITC-Dextran (Invitrogen, D1844).Hyperpermeability of the monolayer is induced by addition of thrombin toa final concentration of 0.5 U/ml. Medium samples are collected from thelower chamber every 30 min and relative fluorescence as a parameter forchanges of macromolecular permeability over time is measured in asuitable fluorimeter. Thrombin challenge induces almost a doubling ofFITC-dextran transition across the endothelial monolayers. In a typicalexperiment compounds are tested in a concentration range of 1×10⁻¹⁰ to1×10⁻⁶ M.

The embodiment examples inhibit the thrombin induced hyperpermeabilityin this test at concentrations of ≦10⁻⁶ M.

2. Test Descriptions (In Vivo) 2a) Measurement of Blood Pressure andHeart Rate in Telemetered, Normotensive Wistar Rats

The cardiovascular effects induced by compounds according to theinvention are investigated in freely moving conscious female Wistar rats(body weight >200 g) by radiotelemetric measurement of blood pressureand heart rate. Briefly, the telemetric system (DSI Data ScienceInternational, MN, USA) is composed on 3 basic elements: implantabletransmitters (TA11PA-C40), receivers (RA1010) and a computer-basedacquisition software (Dataquest™ A.R.T. 4.1 for Windows). Rats areinstrumented with pressure implants for chronic use at least 14 daysprior to the experiments. The sensor catheter is tied with 4-0 sutureseveral times to produce a stopper 0.5 cm from the tip of the catheter.During catheter implantation rats are anesthetized with pentobabital(Nembutal, Sanofi: 50 mg/kg i.p.). After shaving the abdominal skin, amidline abdominal incision is made, and the fluid-filled sensor catheteris inserted upstream into the exposed descending aorta between the iliacbifurcation and the renal arteries. The catheter is tied several timesat the stopper. The tip of the telemetric catheter is located justcaudal to the renal arteries and secured by tissue adhesive. Thetransmitter body is affixed to the inner peritoneal wall before closureof abdomen. A two-layer closure of the abdominal incision is used, withindividual suturing of the peritoneum and the muscle wall followed byclosure of the outer skin. For postsurgical protection againstinfections and pain a single dosage of an antibiotic (Oxytetracyclin 10%R, 5.0 ml/kg s.c., beta-pharma GmbH&Co, Germany) and analgesic isinjected (Rimadyl R, 5.0 ml/kg s.c., Pfizer, Germany). The hardwareconfiguration is equipped for 24 animals. Each rat cage is positioned ontop of an individual receiver platform. After activation of theimplanted transmitters, an on-line data acquisition system, samples dataand converts telemetric pressure signals to mm Hg. A barometric pressurereference allows for relation of absolute pressure (relative to vacuum)to ambient atmospheric pressure. Data acquisition software is predefinedto sample hemodynamic data for 10-s intervals every 5 minutes. Datacollection to file is started 2 hours before administration of testcompounds and finished after completion of 24-h cycles. In a typicalexperiment test compounds are administered as bolus eithersubcutaneously or intravenously at does of 1 to 1000 μg/kg body weight(as referred to the peptide component).

Wild type adrenomedullin (Bachem, H-2932) induces blood pressurereduction in this test with duration of ≦4 h when tested at doses of≦300 μg/kg body weight [FIG. 1].

FIG. 1: 24 hour profiles of mean arterial blood pressure (MABP) recordedfrom telemeterd normotensive female Wistar rats after subcutaneousadministration of ADM or vehicle as indicated (dotted line). Data pointswere plotted as means±SEM of averaged 30 min intervals from 4 animalsper group. One hour after administration animals treated with ADM showeda mean reduction of MABP of almost 20% at peak (filled circles). Afterabout 3.5 hours MABP had returned to base line levels and was in therange of that of vehicle treated animals (open circles).

In this test substances according to the present invention induce bloodpressure reduction of up to 10 h at doses of ≦500 μg/kg body weight (asreferred to the peptide component) [FIG. 2].

FIG. 2: 24 hour profiles of mean arterial blood pressure (MABP) recordedfrom telemeterd normotensive female Wistar rats after subcutaneousadministration of example 1 or vehicle as indicated (dotted line). Datapoints were plotted as means±SEM of averaged 30 min intervals from 6animals per group. Administration of example 1 at a dose of 150 μg/kg(as referred to the peptide component) reduced MABP by about 15 to 19%until 6 h after administration (filled circles). Between 6 h and 14 hafter administration MABP gradually returned to baseline values andfinally was in the range of that of vehicle treated animals.

2b) Skin Vascular Leak Assay in Wistar Rats

An intracutaneous histamine challenge test is employed to assess theeffect of compounds according to the invention on vascular barrierfunction in healthy animals. Male Sprague Dawley rats (body weight >200g) are anesthetized with isoflurane (2%-3% in ambient air) and broughtinto supine position. The abdomen is shaved and a catheter is insertedinto the femoral vein. Vehicle only (0.5 ml PBS+0.1% bovine serumalbumin) or test compounds at appropriate doses are administered as i.v.bolus injections. After 15 min a second injection of 100 μl/kg 2% Evansblue (Sigma) solution is administered and immediately thereafter 100 μlof histamine solutions of appropriate concentrations (for example0-2.5-5-10-20-40 g/ml) are injected intracutaneously into the abdominalskin. Evans blue is a highly plasma protein bound dye and therefore usedas an indicator for protein-rich fluid extravasation and vascularleakage. 30 min after this procedure the rats are sacrificed by anoverdose of isoflurane and subsequent neck dislocation and the abdominalskin is excised. The wheals are excised by use of an 8 mm biopsy punch,the tissue samples are weighted and transferred to formamide for 48 h inorder to extract the Evans blue. Samples are measured at 620 nM and 750nM wavelength on a suitable photometer and Evans blue content of thesamples is corrected for heme pigments according to the formula A620(corrected)=A620−(1.426×A750+0.030) and calculated against a standardcurve. [method adapted from Wang L. F., Patel M., Razavi H. M., WeickerS., Joseph M. G., McCormack D. G., Mehta S., Am. Respir Grit Care Med,165(12), 1634-9 (2002)].

Substances according to the present invention reduce extravasation ofprotein rich plasma fluid induced by histamine challenge in this test.

2c) Intra-Tracheal Instillation of LPS in Mice

An intra-tracheal challenge with lipopolysaccharide (LPS) is employed toexamine the effects of compounds according to the invention on acutelung injury. Male BALB/c mice (average animal weight 20-23 g) areanesthetized with isoflurane (7%) and LPS from E. coli (e.g. serotype055:B5; Sigma) is instilled in 100 μl saline by use of a micropipette.Typical doses of LPS used for challenge are in the range of 1 to 10mg/kg body weight. At different time points before and afterinstillation test compounds are administered by the subcutaneous route.Typical doses are in the range of 1 to 300 μg/kg body weight. In thistest typical time points of administration of test compounds are 15 minbefore or 1 h after LPS challenge. 48 hours after instillation of LPSmice are deeply anesthetized with isoflurane and sacrificed bydislocation of the neck. After cannulation of the trachea lavage of thebronchoalveolar space with 0.5 ml ice-cold saline is performed. Lungsare prepared and weighted. Cells in the bronchoalveolar lavage fluid(BALF) are counted on a cell counter (Cell Dyn 3700, Abbott). In thistest lung weight as a measure for lung edema is reproducibly found to beincreased by about 50% or more over sham controls 48 hours after LPSchallenge. As lung weights show only very low variability in the groups,the absolute lung weight is used as parameter. The counts for whiteblood cells are always found to be significantly increased over controlin the BALF after LPS challenge.

Administration of substances according to the present invention resultedin significantly reduced lung weight and white blood cell counts in theBALF after 48 h when administered as bolus at doses ≦300 g/kg bodyweight (as referred to the peptide component).

2d) Induction of Acute Lung Injury in Mini Pigs

Acute lung injury is induced in anesthetized mini pigs by use oflipopolysaccharide (LPS) or olcic acid as challenges. In detail: femaleGöttingen minipigs of ca. 3.5 to 5.5 kg body weight (Ellegaard, Denmark)are kept anesthetized by an continuous i.v.-infusion of Ketavet®,Dormicum® and Pancuronium® after premedication with an intramuscularinjection of Ketavet®/Stresnil®. After intratracheal intubation animalsare artificially ventilated using a pediatric respirator (Sulla 808V;Drlger, Germany) with an oxygen air mixture at a tidal volume of 30 to50 ml and constant frequency of 25 min⁻¹. Arterial PaCO₂ is adjusted toabout 40 mmHg by regulating the fraction of inspired oxygen (FiO₂) viathe ratio of oxygen air mixture. Routinely the following cardiovascularand respiratory parameters are measured after placement of necessaryprobes and catheters fitted to appropriate pressure transducers andrecording equipment: central venous pressure (via left jugular vein),arterial blood pressure and heart rate (BP and HR; via left carotidartery), left ventricular pressure (LVP; using a Millar catheter [FMI,Mod.:SPC-340S, REF: 800-2019-1, 4F] introduced into the left ventriclevia right carotid artery), pulmonary arterial pressure (PAP; using ARROWBerman angiographic balloon catheter [REF.: AI-07134 4 Fr. 50 cm] placedinto the pulmonary artery via left jugular vein), cardiac output (CO)and extravascular lung water index (EVWLI) by use of the PiCCO system(Pulsion, Germany) connected to a Pulsion 4F Thermodilution-catheter(PV2014L08N) placed into the right femoral artery. Catheters formeasurement of CVP, BP, HR, LVP, and PAP are fitted to a Ponemahrecording system. Arterial blood gas analysis is performed to determinethe PaO₂/FiO₂. According to the American-European Consensus Conferenceon ARDS a PaO₂/FiO₂<300 mmHg is considered as indicative for thepresence of acute lung injury. Dependent on the applied protocolduration of experiments varied between 4 and 5 hours afteradministration of lung injury inducing challenge. At the end ofexperimentation pigs are sacrificed by exsanguination andbronchoalveolar lavage fluid (BALF) is collected from lungs. Cellularcontent of BALF is determined by use of a blood cell counter (Cell DYN3700).

In a typical setting acute lung injury is induced by intratrachealinstillation of Lipopolysaccharide (LPS; E. coli 0111:B4; Sigma L2630)in saline at a dose of 5 mg/kg body weight into each lung via theendotracheal tube. PAP and EVWLI increased while PaO₂/FiO₂ decreasedbelow 300 mmHg in response to the challenge. The cellular content ofBALF is significantly increased. Administration of compound 1 of thisinvention as i.v.-bolus 15 min before the LPS challenge ameliorated orprevented the LPS induced changes.

In an other protocol oleic acid (OA; Sigma-Aldrich, 01008) diluted withethanol (1:1) is infused i.v. over 15 min at a final dose of 100 mg/kgbody weight. Challenge with OA led to increase of PAP and EVLWI anddecrease of PaO₂/FiO₂ below 300 mmHg. Changes are ameliorated orprevented by administration of compound 1 of this invention 15 minbefore start of the OA infusion.

Doses of example 1 ≦30 μg/kg body weight (as referred to the peptidecomponent) were found to be active in the described test systems.

C. EXEMPLARY EMBODIMENTS OF PHARMACEUTICAL COMPOSITIONS

The compounds according to the invention can be converted intopharmaceutical preparations in the following ways:

i.v. Solution:

A compound according to the invention is dissolved at a concentrationbelow saturation solubility in a physiologically acceptable solvent (forexample buffers of pH 4 to pH 7, isotonic sodium chloride solution,glucose solution 5% and/or PEG 400 solution 30%). The solution issterilized by filtration and filled into sterile and pyrogen-freeinjection containers.

s.c. Solution:

A compound according to the invention is dissolved at a concentrationbelow saturation solubility in a physiologically acceptable solvent (forexample for example buffers of pH 4 to pH 7, isotonic sodium chloridesolution, glucose solution 5% and/or PEG 400 solution 30%). The solutionis sterilized by filtration and filled into sterile and pyrogen-freeinjection containers.

1-12. (canceled)
 13. A pharmaceutical composition comprising a compoundof the formula (I)

in which n represents the number 0, 1, 2 or 3, R¹ represents hydrogen,methyl, ethyl, n-propyl or isopropyl, R² represents linear or branchedPEG 20 kDa to 80 kDa endcapped with a methoxy-group, or a salt thereof,in combination with an inert nontoxic pharmaceutically suitableexcipient, wherein the pharmaceutical composition is in a pharmaceuticalform for administration by inhalation.
 14. The pharmaceuticalcomposition of claim 13, wherein n represents the number 1 or 2, R¹represents hydrogen or methyl, R² represents linear PEG 40 kDa endcappedwith a methoxy-group.
 15. The pharmaceutical composition of claim 13,wherein n represents the number 1 or 2, R¹ represents hydrogen, R²represents linear PEG 40 kDa endcapped with a methoxy-group.
 16. Thepharmaceutical composition of claim 13, wherein the pharmaceutical formfor administration by inhalation is selected from the group consistingof a powder inhaler, a nebulizer, a solution or a spray.
 17. Thepharmaceutical composition of claim 13, further comprising an activeingredient selected from the group consisting of ACE inhibitors,angiotensin receptor antagonists, beta-2 receptor agonists,phosphodiesterase inhibitors, glucocorticoid receptor agonists,diuretics, or recombinant angiotensin converting enzyme-2 andacetylsalicylic acid (aspirin).
 18. The pharmaceutical composition ofclaim 17, wherein the active ingredient is selected from an ACEinhibitor selected from the group consisting of enalapril, quinapril,captopril, lisinopril, ramipril, delapril, fosinopril, perindopril,cilazapril, imidapril, benazepril, moexipril, spirapril and trandopril,an angiotensin receptor antagonist, selected from the group consistingof losartan, candesartan, valsartan, telmisartan and embusartan, anbeta-2 receptor agonist, selected from the group consisting ofsalbutamol, pirbuterol, salmeterol, terbutalin, fenoterol, tulobuterol,clenbuterol, reproterol and formoterol, a phosphodiesterase (PDE)inhibitor selected from the group consisting of milrinone, amrinone,pimobendan, cilostazol, sildenafil, vardenafil and tadalafil, aglucocorticoid receptor agonist selected from the group consisting ofcortiosol, cortisone, hydrocortisone, prednisone, methyl-prednisolone,prednylidene, deflazacort, fluocortolone, triamcinolone, dexamethasoneand betamethasone, a diuretic selected from the group consisting offurosemide, torasemide and hydrochlorothiazide, recombinant angiotensinconverting enzyme-2 and acetylsalicylic acid (aspirin).
 19. A method fortreating a cardiovascular, edematous and/or inflammatory disorderselected from the group consisting of heart failure, coronary heartdisease, ischemic and/or hemorrhagic stroke, hypertension, pulmonaryhypertension, peripheral arterial occlusive disease, pre-eclampsia,chronic obstructive pulmonary disease, asthma, acute and/or chronicpulmonary edema, allergic alveolitis and/or pneumonitis due to inhaledorganic dust and particles of fungal, actinomycetic or other origin,and/or acute chemical bronchitis, acute and/or chronic chemicalpulmonary edema, neurogenic pulmonary edema, acute and/or chronicpulmonary manifestations due to radiation, acute and/or chronicinterstitial lung disorders, acute lung injury/acute respiratorydistress syndrome (ALI/ARDS) in adult or child including newborn,ALI/ARDS secondary to pneumonia and sepsis, aspiration pneumonia andALI/ARDS secondary to aspiration, ALI/ARDS secondary to smoke gasinhalation, transfusion-related acute lung injury (TRALI), ALI/ARDSand/or acute pulmonary insufficiency following surgery, trauma and/orburns, and/or ventilator induced lung injury (VILI), lung injuryfollowing meconium aspiration, pulmonary fibrosis, mountain sickness,glomerulonephritis, acute kidney injury, cardiorenal syndrome,lymphedema, inflammatory bowel disease, sepsis, septic shock, systemicinflammatory response syndrome (SIRS) of non-infectious origin,inflammatory bowel disease and urticaria, comprising administering to ahuman or animal an active amount of the pharmaceutical composition as inclaim
 13. 20. The method for treating of claim 19, wherein thecardiovascular, edematous and/or inflammatory disorder is selected fromthe group consisting of pulmonary hypertension, chronic obstructivepulmonary disease, asthma, acute and/or chronic pulmonary edema,allergic alveolitis and/or pneumonitis due to inhaled organic dust andparticles of fungal, actinomycetic or other origin, and/or acutechemical bronchitis, acute and/or chronic chemical pulmonary edema,neurogenic pulmonary edema, acute and/or chronic pulmonarymanifestations due to radiation, acute and/or chronic interstitial lungdisorders, acute lung injury/acute respiratory distress syndrome(ALI/ARDS) in adult or child including newborn, ALI/ARDS secondary topneumonia and sepsis, aspiration pneumonia and ALI/ARDS secondary toaspiration, ALI/ARDS secondary to smoke gas inhalation,transfusion-related acute lung injury (TRALI), ALI/ARDS and/or acutepulmonary insufficiency following surgery, trauma and/or burns, and/orventilator induced lung injury (VILI), lung injury following meconiumaspiration, pulmonary fibrosis, mountain sickness.
 21. A method forpreventing a cardiovascular, edematous and/or inflammatory disorderselected from the group consisting of heart failure, coronary heartdisease, ischemic and/or hemorrhagic stroke, hypertension, pulmonaryhypertension, peripheral arterial occlusive disease, pre-eclampsia,chronic obstructive pulmonary disease, asthma, acute and/or chronicpulmonary edema, allergic alveolitis and/or pneumonitis due to inhaledorganic dust and particles of fungal, actinomycetic or other origin,and/or acute chemical bronchitis, acute and/or chronic chemicalpulmonary edema, neurogenic pulmonary edema, acute and/or chronicpulmonary manifestations due to radiation, acute and/or chronicinterstitial lung disorders, acute lung injury/acute respiratorydistress syndrome (ALI/ARDS) in adult or child including newborn,ALI/ARDS secondary to pneumonia and sepsis, aspiration pneumonia andALI/ARDS secondary to aspiration, ALI/ARDS secondary to smoke gasinhalation, transfusion-related acute lung injury (TRALI), ALI/ARDSand/or acute pulmonary insufficiency following surgery, trauma and/orburns, and/or ventilator induced lung injury (VILI), lung injuryfollowing meconium aspiration, pulmonary fibrosis, mountain sickness,glomerulonephritis, acute kidney injury, cardiorenal syndrome,lymphedema, inflammatory bowel disease, sepsis, septic shock, systemicinflammatory response syndrome (SIRS) of non-infectious origin,inflammatory bowel disease and urticaria, comprising administering to ahuman or animal an active amount of a pharmaceutical composition claim13.
 22. The method for preventing of claim 21, wherein thecardiovascular, edematous and/or inflammatory disorder is selected fromthe group consisting of pulmonary hypertension, chronic obstructivepulmonary disease, asthma, acute and/or chronic pulmonary edema,allergic alveolitis and/or pneumonitis due to inhaled organic dust andparticles of fungal, actinomycetic or other origin, and/or acutechemical bronchitis, acute and/or chronic chemical pulmonary edema,neurogenic pulmonary edema, acute and/or chronic pulmonarymanifestations due to radiation, acute and/or chronic interstitial lungdisorders, acute lung injury/acute respiratory distress syndrome(ALI/ARDS) in adult or child including newborn, ALI/ARDS secondary topneumonia and sepsis, aspiration pneumonia and ALI/ARDS secondary toaspiration, ALI/ARDS secondary to smoke gas inhalation,transfusion-related acute lung injury (TRALI), ALI/ARDS and/or acutepulmonary insufficiency following surgery, trauma and/or burns, and/orventilator induced lung injury (VILI), lung injury following meconiumaspiration, pulmonary fibrosis, mountain sickness.
 23. A compound of theformula (II)

or its salt, solvate, or a solvate of the salt.
 24. A compound of theformula (III)